Lyme Disease: Learning from ID Connect
On April 20th, 2022 the nurses from Health Care Quality Units (HCQU’s) across the state of Pennsylvania (PA) had the opportunity to participate in a live webinar given by ID Connect physician, Dr. Antoine Auguste, MD, MPH, on Lyme Disease. Living in Western PA, I am sure that you or someone you know has been bitten by a tick. Lyme disease is prevalent in 15 states in the U.S.A., including PA. The full list is: Connecticut, Delaware, District of Columbia, Maine, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, and Wisconsin.
Lyme disease is caused by a bacterial infection of the Borrelia species. It is transmitted by the bite of an infected tick. An important fact to know is that ticks do not jump or fly. They tend to be found in wooded areas or grasses and simply crawl onto a host as the victim brushes past.
Deer ticks have four stages in their life cycle: egg, larva, nymph, and then adult. Present in all 67 counties in PA, deer ticks are a real threat. According to the presentation, ¼ of all nymphs and ½ of all adult ticks tested were positive for B. Burgdorferi, the bacteria that causes Lyme. Pennsylvania reports more than 10,000 cases yearly. Most infections are transmitted by the nymph because of their small poppy seed size. Nymphs are present from May through July; this is the time of year we are outside the most. So always make sure to help those you support check for ticks. Of course, any tick in the lifecycle can transmit Lyme. However, the adult tick tends to be abundant in the fall and is noticed more often because of its large size.
When we think of Lyme Disease, we think of three stages. The first is early localized stage. The second is early disseminated stage, and the third is late disease. In the early localized, which is typically within one month of being bitten by a tick, we may notice a rash. We tend to think of the characteristic bullseye rash, but it can also appear as a full pink/red oval. The person may also exhibit flu-like symptoms and swollen lymph nodes. In the early disseminated stage, there may be multiple rash lesions. These areas tend to occur below the neck and above the ankles. The rash lesions are often smaller than the original. The person continues to have fever and flu-like symptoms and swollen lymph nodes. They may have Bell’s Palsy, which causes one-sided facial paralysis, meningitis, and possible sensory or motor issues. There can also be cardiac issues from infection. This can include 1st, 2nd, or 3rd degree heart block. The person may need a temporary pacemaker. They may also develop arthritis. This stage can be weeks to months after a tick bite. The late disease stage typically occurs months to years after the person is bitten with an infected tick. The person may develop inflammatory arthritis which effects the knees most commonly. There may be chronic motor and sensory issues. While widespread brain dysfunction is rare there may be subtle cognitive dysfunction due to overall body illness.
Behavioral symptoms of Lyme may include:
– New or increased aggression/irritability
– Refusal to engage in tasks
– Refusal to walk/move
– Hitting own/other’s head
– Hitting or rubbing chest
– Increased confusion
Next, we come to testing. We typically see a two-tier approach. This includes the ELISA and Western Blot. There can be many false positives with the ELISA, so a Western Blot is always done to confirm. Blood testing is not very sensitive in the early localized stage or in the first few weeks. The sensitivity increases greatly in the early disseminated and late disseminated stages. Blood tests may remain positive for years and cannot be used to measure treatment response.
Lyme disease is treated effectively with antibiotics. The treatment time ranges from 10-14 days with oral antibiotics or IV antibiotics dependent on the symptoms. In about 1/20 people there may be symptoms such as pain, fatigue, difficulty with memory, or cognitive impairment that may last 6 months after treatment. In chronic Lyme disease cases there are no proven treatments. There is also a risk of co-infection with another pathogen. Specific types of co-infections are localized to certain areas. Reinfection can occur if a person is bitten by another infected tick; that’s why it is so important we protect ourselves and those we support.
How can you protect yourself?
Wear light colored clothing, including long sleeved shirts, and use an EPA approved repellent. These can be repellants containing DEET, picaridin, oil of lemon eucalyptus, para menthane-diol or 2-undecanone. You should treat clothing and gear with products containing 0.5% permethrin. It is important to also treat dogs and cats for ticks. Additional protection should include checking yourself and those you support daily for ticks. Pay particularly close attention to under arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and along the hairline and scalp. Shower soon after being outdoors. Put clothing in dryer on high heat after coming indoors to kill ticks. Avoid tick habitats. Reduce tick habitats in your yard.
If you do find a tick, how do you safely remove it?
Use fine tipped tweezers to grasp the tick as close to the skin surface as possible. Pull upward with steady even pressure. Clean the bite area and your hands with rubbing alcohol, iodine scrub, or soap and water.
From my experience Lyme disease is often not a consideration in the people we support. Being that we live in one of the States with the highest rate of transmission we need to keep this disease in mind when advocating for those we support. But remember, prevention is always key. Educate the people you support. Help them, if needed, to check their body for ticks. Stay alert because although you can get bitten any time of year, we are entering a high transmission time of year!
